【摘要】 目的:探讨不同的呼气末正压（PEEP）水平对重型颅脑损伤合并急性呼吸窘迫综合征（ARDS）患者肺气体交换、脑灌注、颅内压的影响。方法:以20例重型颅脑损伤合并ARDS患者为研究对象,GCS评分为3⁸分,记录不同PEEP下颅内压（ICP）、脑灌注压（CPP）、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、氧合指数（PaO₂/FiO₂）。结果:当PEEP由4 cm H₂O升至8 cm H₂O时,ICP无明显变化,至12 cm H₂O以上时ICP较PEEP为4 cm H₂O时,差异有统计学意义（12 cm H₂O时P<0.05,16 cm H₂O时P<0.01）。随PEEP增加,PaO₂呈上升趋势,PEEP为8、12、16 cm H₂O时同4 cm H₂O时比较,差异有统计学意义（P<0.01）;PEEP为8、12、16 cm H₂O时同4 cm H₂O时比较,PaCO₂差异有统计学意义（P<0.01）;PaO₂/FiO₂随PEEP增加增大,PEEP为8、12、16 cm H₂O时同4 cm H₂O时比较,差异有统计学意义（P<0.01）;MAP、CPP随PEEP的升高,呈下降趋势,PEEP为8、12、16 cm H₂O时同4 cm H₂O时比较,差异有统计学意义（P<0.01）。结论:使用PEEP在4¹6 cm H₂O范围治疗重型颅脑损伤合并ARDS患者,为相对安全范围,治疗应个体化调节。更多还原

【Abstract】 Objective:To explore the effect of different levels positive end-expiratory pressure on air exchange,cerebral perfusion and intracranial pressure of the patients with cerebral injury complicated with acute respiratory distress syndrome.Method:20 patients with severe craniocerebral injury complicated with ARDS were studied,whose GCS scores were 3 to 8 points.Their intracranial pressure（ICP）,cerebral perfusion pressure（CPP）,arterial partial pressure of oxygen（PaO₂）,partial pressure of carbon dioxide in artery（PaCO₂） and oxygenation index（PaO₂/FiO₂） were recorded.Result:When PEEP was increased from 4 to 8 cm H₂O,ICP had no obvious change,but to more than 12 cm H₂O,the differences were statistically significant（increased to 12 cm H₂O,P<0.05,to 16 cm H₂O,P<0.01）.With the increase of PEEP,PaO₂ was rised,as PEEP was increased to 8,12 and 16 cm H₂O,compared to 4 cm H₂O,the differences were statistically significant（P<0.01）.When PEEP was increased to 8,12 and 16 cm H₂O,the PaCO₂ was statistically significant compared to 4 cm H2O（P<0.01）.PaO₂/FiO₂ increased with the rising of PEEP,When PEEP was increased to 8,12 and 16 cm H₂O,the difference was statistically significant compared to 4 cm H2O（P<0.01）.There was a downward trend of MAP and CPP when PEEP was increased,when PEEP was increased to 8,12 and 16 cm H₂O,the difference was statistically significant compared to 4 cm H2O（P<0.01）.Conclusion:When PEEP is increased from 4 to 16 cm H₂O,it is relatively in a safe range,the treatment shall be individualized.更多还原